Analyzing the Key Predictors of Implant Cut Out in DHS-Treated Intertrochanteric Fractures: A Comprehensive Investigation

Implant Cut Out in DHS-Treated Intertrochanteric Fractures


  • Omer Farooq Tanveer Department of Orthopedics, Khawaja Muhammad Safdar Medical College, Sialkot, Pakistan
  • Muhammad Maaz Arif Department of Medical Education, University of Health Sciences, Lahore, Pakistan
  • Danish Mohsin Department of Medical Education, University of Health Sciences, Lahore, Pakistan
  • Wardah Nisar Department of Public Health, University of Health Sciences, Lahore, Pakistan
  • Naveen Abubakar Bugvi Department of Diagnostic Radiology, King Edward Medical University, Lahore, Pakistan
  • Noreen Maqbool Bohari Department of Community Medicine, Khawaja Muhammad Safdar Medical College, Sialkot, Pakistan
  • Tanveer Haider Department of Orthopedics, Khawaja Muhammad Safdar Medical College, Sialkot, Pakistan
  • Muhammad Abdul Hannan Department of Orthopedics, Khawaja Muhammad Safdar Medical College, Sialkot, Pakistan
  • Rizwan Anwar Department of Orthopedics, Khawaja Muhammad Safdar Medical College, Sialkot, Pakistan



Intertrochanteric, Fractures, DHS-Treated


Intertrochanteric fractures are osteoporotic fractures in nature that mainly affect elderly people and lead to disability annually. This creates a burden on the healthcare system and results in significant resource usage, attention to medical needs, and rehabilitative care. Objective: To identify and analyze the key factors associated with intertrochanteric fractures. Methods: A cross-sectional study was conducted at Khawaja Muhammad Safdar Medical College (KMSMC) in Sialkot, Pakistan. This observational study enrolled 137 patients, with 63 males (46%) and 74 females (54%). Results: The average age of the selected group was 64.55±14.26 years. It was highlighted that most of the fractures (52%) were on the right side, this features a potential asymmetry in fracture development. Secondly, falls were recognized as the prime reason for intertrochanteric fractures, as it accounts for 65% of the cases. As per fracture classification taken into account, stable fractures (64%) were the most common type noticed. Furthermore, a large part of patients (76%) encountered a positive outcome in terms of union, mentioning a successful healing of the fractures. Besides, a notable percentage (52%) of the cases exhibit good reduction, demonstrating functional alignment of fractured bone segments in the course of the treatment procedure. Conclusions: The present study deduced that a remarkable number of fractures were observed on the right side, specifying a possible imbalance in fracture occurrence. Furthermore, falls were regarded as the primary cause of intertrochanteric fractures. Majority were stable in nature with positive union outcomes and showed a good reduction.


Kahane S, Vaghela KR, Stammers J, Goldberg A, Smitham P. Biomechanical Study Comparing Cut-out Resistance of the X-Bolt® and Dynamic Hip Screw at Various Tip-Apex Distances. Surgical Technology International. 2019 Nov; 35: 395-401.

Kazemian G, Rasi AM, Barati H, Omidian MM, Omrani FA, Feizi D, et al. The comparison of fixation and cut-out of proximal intramedullary nail and dynamic hip screw therapy in the treatment of stable intertrochanteric fractures of the femur: A retrospective study. Journal of Critical Reviews. 2020 Jan; 7(2): 10-4. doi: 10.31838/jcr.07.02.03.

Papadimitriou N, Tsilidis KK, Orfanos P, Benetou V, Ntzani EE, Soerjomataram I, et al. Burden of hip fracture using disability-adjusted life-years: a pooled analysis of prospective cohorts in the CHANCES consortium. The Lancet Public Health. 2017 May; 2(5): e239-46. doi: 10.1016/S2468-2667(17)30046-4.

Hussain KS, Reddy AS, Raju M, Patnala C. Influence of risk factors for hip injuries and effect of co-morbidities on postoperative complications and outcome after hip fracture surgery in the elderly. Journal of Orthopaedic Diseases and Traumatology. 2023 Jan; 6(1): 32-40. doi: 10.4103/jodp.jodp_38_22.

Chowdhury AK, Townsend O, Edwards MR. A comparison of hemiarthroplasty versus dynamic hip screw fixation for intertrochanteric femoral fractures: a systematic review. Hip International. 2023 Jul; 33(4): 752-61. doi: 10.1177/11207000221112579.

Niemann M, Braun KF, Ahmad SS, Stöckle U, Märdian S, Graef F. Comparing perioperative outcome measures of the dynamic hip screw and the femoral neck system. Medicina. 2022 Feb; 58(3): 352. doi: 10.3390/medicina58030352.

Fan J, Xu X, Zhou F. The lateral femoral wall thickness on the risk of post-operative lateral wall fracture in intertrochanteric fracture after DHS fixation: A finite element analysis. Injury. 2022 Feb; 53(2): 346-52. doi: 10.1016/j.injury.2021.11.015.

Mao W, Ni H, Li L, He Y, Chen X, Tang H, et al. Comparison of Baumgaertner and Chang reduction quality criteria for the assessment of trochanteric fractures. Bone & Joint Research. 2019 Oct; 8(10): 502-8. doi: 10.1302/2046-3758.810.BJR-2019-0032.R1.

Garabano G, Pesciallo CA, Alamino LP, Ernst G, Del Sel H. Bipolar hemiarthroplasty in unstable intertrochanteric fractures in elderly patients. The predictive value of the Charlson Comorbidity Index in 1-year mortality. Journal of Clinical Orthopaedics and Trauma. 2022 Feb; 25: 101743. doi: 10.1016/j.jcot.2021.101743.

Stockton DJ, Dua K, O'Brien PJ, Pollak AN, Hoshino CM, Slobogean GP. Failure patterns of femoral neck fracture fixation in young patients. Orthopedics. 2019 Jul; 42(4): e376-80. doi: 10.3928/01477447-20190321-03.

Piltz S, Rubenbauer B, Böcker W, Trentzsch H. Reduction and fixation of displaced U-shaped sacral fractures using lumbopelvic fixation: technical recommendations. European Spine Journal. 2018 Dec; 27: 3025-33. doi: 10.1007/s00586-017-5368-0.

Kyriakopoulos G, Panagopoulos A, Pasiou E, Kourkoulis SK, Diamantakos I, Anastopoulos G, et al. Optimizing fixation methods for stable and unstable intertrochanteric hip fractures treated with sliding hip screw or cephalomedullary nailing: A comparative biomechanical and finite element analysis study. Injury. 2022 Dec; 53(12): 4072-85. doi: 10.1016/j.injury.2022.10.006.

Soni A, Munshi S, Radhamony NG, Nair R, Sreenivasan S. Dynamic hip screw plate length in stable intertrochanteric fracture neck of femur: a systematic review. Cureus. 2022 Mar; 14(3): e23138. doi: 10.7759/cureus.23138.

Cun Y, Dou C, Tian S, Li M, Zhu Y, Cheng X, et al. Traditional and bionic dynamic hip screw fixation for the treatment of intertrochanteric fracture: a finite element analysis. International Orthopaedics. 2020 Mar; 44: 551-9. doi: 10.1007/s00264-019-04478-9.

Raina DB, Markevičiūtė V, Stravinskas M, Kok J, Jacobson I, Liu Y, et al. A new augmentation method for improved screw fixation in fragile bone. Frontiers in Bioengineering and Biotechnology. 2022 Mar; 10: 816250. doi: 10.3389/fbioe.2022.816250.

Lil NA, Makwana VR, Patel TD, Patel AR. Comparative study of intertrochanteric fracture fixation using proximal femoral nail with and without distal interlocking screws. World Journal of Orthopedics. 2022 Mar; 13(3): 267. doi: 10.5312/wjo.v13.i3.267.

Jeong BC, Goh TS, Lee C, Ahn TY, Ryu D. Identification of screw spacing on pediatric hip locking plate in proximal femoral osteotomy. Physical and Engineering Sciences in Medicine. 2023 May; 46: 1101-1114. doi: 10.1007/s13246-023-01277-w.

Sun H, Shu LY, Sherrier MC, Zhu Y, Liu JW, Zhang W. Decreased complications but a distinctive fixation loosening mechanism of fully threaded headless cannulated screw fixation for femoral neck fractures in young adults. Journal of Orthopaedic Surgery and Research. 2021 Dec; 16(1): 1-3. doi: 10.1186/s13018-021-02335-3.

Blandi L, Bertuccio P, Amorosi A, Clemens T, Brand H, Odone A. 20-Year trends of hospitalisation among people with dementia: a region-wide retrospective cohort study from Lombardy, Italy. Public Health. 2023 Sep; 222: 21-8. doi: 10.1016/j.puhe.2023.06.036.

George J, Sharma V, Farooque K, Mittal S, Trikha V, Malhotra R. Injury mechanisms of hip fractures in India. Hip & Pelvis. 2021 Jun; 33(2): 62. doi: 10.5371/hp.2021.33.2.62.

Tiihonen R, Helkamaa T, Nurmi-Lüthje I, Kaukonen JP, Kataja M, Lüthje P. Patient-specific factors affecting survival following hip fractures—a 14-year follow-up study in Finland. Archives of Osteoporosis. 2022 Dec; 17(1): 107. doi: 10.1007/s11657-022-01148-z.

Hongku N, Woratanarat P, Nitiwarangkul L, Rattanasiri S, Thakkinstian A. Fracture fixation versus hemiarthroplasty for unstable intertrochanteric fractures in elderly patients: A systematic review and network meta-analysis of randomized controlled trials. Orthopaedics & Traumatology: Surgery & Research. 2022 Feb; 108(1): 102838. doi: 10.1016/j.otsr.2021.102838.

Su BW, Heyworth BE, Protopsaltis TS, Lipton CB, Sinicropi SM, Chapman CB, et al. Basicervical versus intertrochanteric fractures: an analysis of radiographic and functional outcomes. Orthopedics. 2006 Oct; 29(10): 919. doi: 10.3928/01477447-20061001-04.

Kaya O, Buyukbebeci O, Gonder N, Karsli B, Isik M, Senel A. Clinical and radiological results of patients with femoral intertrochanteric fractures treated with proximal femoral nailing. Medicine Science. 2022 Jun; 11(2): 864-8. doi: 10.5455/medscience.2021.12.410.



DOI: 10.54393/tt.v4i03.142
Published: 2023-09-30

How to Cite

Tanveer, O. F., Arif, M. M., Mohsin, D., Nisar, W., Bugvi, N. A., Bohari, N. M., Haider, T., Hannan, M. A. ., & Anwar, R. (2023). Analyzing the Key Predictors of Implant Cut Out in DHS-Treated Intertrochanteric Fractures: A Comprehensive Investigation: Implant Cut Out in DHS-Treated Intertrochanteric Fractures. THE THERAPIST (Journal of Therapies &Amp; Rehabilitation Sciences), 4(03), 08–12.